VACCINES--HOW A MILLENNIA-OLD LIFESAVER WAS AND STILL IS CONTROVERSIAL: Part 2

 Anti-vaxxers are nothing new

Opposition to vaccination is not a 20th-21st century phenomenon. It has been prevalent for much longer than many may realize. Here's an intriguing anti-vaccination flyer from 1807 called "The Vaccine Monster," clearly designed to engender feelings of suspicion, disgust and fear.

The Vaccine Monster, 1807 (Image: Wiki Digital Methods)

The text that accompanied this image proclaimed that, "A mighty and horrible monster, with the horns of a bull, the hind of a horse, the jaws of a krakin, the teeth and claws of a tyger, the tail of a cow, all the evils of Pandora's box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body . . . has made his appearance in the world, and devores mankind —especially poor helpless infants—not by sores only, or hundreds, or thousands, but by hundreds of thousands." 

Another flyer from 1894 was accompanied by text warning of the dangers of vaccination.

(Image originally from Historical Medical Library of The College
of Physicians of Philadelphia)

Notice the reference to vaccines being poison and not only ineffective, but actually producing death. Most important is this sentence: "Any dogma of a class, medical or religious, that needs the fostering care of legislative enactment to force it upon the people, shows inherent weakness and condemns it at once among all men." It also claims that the smallpox vaccine caused greater mortality than smallpox itself. 

A Supreme Court Case

In Part 1 of this two-part series, we saw how important the smallpox vaccine became as a preventive measure against a grossly disfiguring and highly contagious disease. By 1902, smallpox vaccination was well established in Boston. Nevertheless, the disease stubbornly hung around, and officials took drastic measures. For instance, public health doctors, accompanied by guards, went to the railway yards and forcibly vaccinated “Italians, negroes and other employees.”

In 1902, Cambridge's Board of Health mandated smallpox vaccination for all residents who had not been vaccinated since 1897. But a naturalized Swedish American called Reverend Henning Jacobson refused to take the vaccination, claiming that Sweden's mandatory vaccination when he was six years old had caused him "great and extreme suffering." He was convicted and fined $5, which he refused to pay. 

                                            Henning Jacobson (Image: New England Historical Society)

In a legal brief, Jacobson stated he rejected a law that compelled ". . . a man to offer up his body to pollution and filth and disease," on the basis of the 14th Amendment, which states in part, "No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States."  Of note, Jacobson made dire references to vaccinations ("filth and disease") that echoed those of the 1807 "Vaccine Monster" flyer. The Jacobson case went to the U.S. Supreme Court, which held that individual liberty is not absolute and is subject to the police power of the state. Jacobson lost the case.

But in 1926, a group of health officers who went to Georgetown, DE to vaccinate the townspeople were met by an armed mob led by a retired Army Lieutenant and a city councilman. The "vaccinators" were driven out. If any of the residents of Georgetown were aware of the 1905 Supreme Court ruling, it evidently made no difference to the ire directed against the authorities.

In 1935, two separate polio vaccine trials using killed and attenuated poliovirus resulted in catastrophic morbidity and mortality in many subjects out of the 11,000 total number of people vaccinated. This doesn't say vaccines are bad; rather it emphasizes the absolute importance of conducting careful trials before a large number of people are administered a vaccine. In 1953, Jonas Salk produced an injected vaccine for polio using a killed virus, and in fact he injected his own family members with it. In 1959, Albert Sabin brought out his oral attenuated virus, which was tried out on, strangely enough, Soviet citizens. In modern times, only the inactivated (injected) poliovirus is used in the U.S., while other countries use the oral form. Throughout the 1900s, many of the vaccines with which we've come to be familiar, e.g. mumps, measles, rubella, rabies, diphtheria, pertussis, meningitis, and chickenpox were developed. In 1972, the smallpox vaccine was no longer routinely administered in the U.S. 

The "Case" Against Vaccines

The objections and resistance to vaccination fall into a number of categories:

• Religion: It isn't that multiple Christian denominations like Roman Catholic, Amish, Anglican, Episcopalian, have an official stance against vaccination. They do not. What we see is the individual who believes that "God is more powerful than any virus," or some similar declaration. These people refuse vaccinations on the basis of their faith. All but two US states allow vaccination exemption on the basis of religion.
• Misconceptions: Just as in foregoing centuries, some believe that vaccines actually give a person the disease or even cause death. This is still the case with the annual influenza vaccine. I have personally taken it every year for more than 20 years, but people still swear (including a surprising number of people in health care) that whenever they get the flu shot, they get the flu. It isn't true. There may be a mild local or systemic reaction, but it is not the flu.
• Concerns about adverse effects: In 1998, Andrew Wakefield published a study in the influential British medical journal, The Lancet, claiming to show that the mumps-measles-rubella (MMR) vaccine could be associated with the development of autism in twelve children. What followed was a circus of accusations and conspiracy theories that the manufacturers of the MMR vaccine were hiding the truth about its causing autism. When the cause of a disease is unknown, those affected will readily latch onto any explanation offered, no matter how flawed. Wakefield's paper was deeply flawed, yet it took The Lancet 12 years to officially retract it. However, humans being what they are, a planted seed puts down deep roots and continues to grow unabated.
• Fear of vaccine ingredients: in 1926, Alexander Glenny increased the effectiveness of the diphtheria toxoid by treating it with aluminum salts. Called an adjuvant, this increases the immune response in a subject. Much later, in 1964, the American Academy of Pediatrics recommended aluminum adjuvant in the combination diptheria-tetanus-pertussis (DTP) vaccine. The amount of aluminum salts contained is in fact less than the amount in normal human breast milk, but many people are under the impression that there are pieces of the metal aluminum floating around in the vaccine. Like the MMR vaccine itself, thimerasol, a preservative containing ethyl mercury, was implicated--falsely--to autism. Since 2001, thimerasol hasn't been used in children's vaccines, although it is still used in the adult flu vaccine unless preservative-free vaccine is specifically requested.
• Immune overload: Many parents falsely believe that the multiple immunizations given to children at a single doctor visit is detrimental to a child because their immune system can't handle them all at once.
• Genocidal agent: prevalent in Africa especially is the belief that vaccines are really an attempt by western countries to kill off black Africans. Most recently, this conspiracy theory has been applied to the putatively upcoming Covid vaccine, and of interest is that Bill Gates is central to that plot. But don't scoff at Africans just yet. Since Gates famously predicted a pandemic back in 2015, some Americans also believe that he started the pandemic himself. (Others decry why he shows up on CNN talking about medical issues when he is not a physician.). But guess what? President Barack Obama actually beat Gates to it (at least on YouTube) when he precisely foresaw a global airborne pandemic such as Covid back in 2014.

Individual Liberty

All those above reasons aside, a powerful theme that has run through the anti-vaxxer's cry from way back in the 1800s until the present day is a strong objection to being told what to do by authorities. People go to a physician for a sore throat and demand antibiotics, but being asked to take a vaccine to prevent illness is a different matter. That is an imposition on one's freedoms, as is wearing a mask to prevent spread of Covid. There are emotional, cultural, and ideological objections to vaccination. Conservative people are less likely to accept or recommend vaccination. Donald Trump has used Twitter to perpetuate the long-debunked linkage between autism and vaccines since as far back as March 2012. However, a well-known liberal, Robert F. Kennedy, Jr. also was a vaccine skeptic. 

Suspicion of government and the perception that authorities are trying to take away personal freedoms are often tied to any number of dark conspiracy theories. These are sometimes triggered by signals from sharply partisan individuals with a platform, such as conservative TV and radio hosts, celebrities such as Jenny McCarthy, and leaders such as President Trump, who has cast aspersions on the CDC, for example. The tangle of ideology, politics, and conspiracy theories is complex, and unfortunately it can have negative and dangerous consequences when it comes to vaccines and vaccination. Since the 19th century, we have made tremendous progress in science and technology, but for some, that "Vaccine Monster" of 1807 is still a reality. 

(Addendum: A correction was made to reflect that the Robert Kennedy who is a vaccine skeptic refers to Robert F. Kennedy, Jr.)

VACCINES--HOW A MILLENNIA-OLD LIFESAVER WAS, AND STILL IS, CONTROVERSIAL--Part 1

Wednesday--Kwei

In the era of Covid-19, we've heard a lot about vaccines and the international race to produce one. However, even if a successful vaccine emerges relatively quickly in the US, studies suggest that only 30-40% of Americans will accept the vaccine. In other words, hurry up and wait. The joint NIH-Moderna Phase 3 trial, which shows a lot of promise, has just hit a snag because they haven't enrolled enough African Americans and Latinx subjects. Because of a long and shocking history of unethical experimentation on black people by white doctors, e.g. the Tuskegee Syphilis Study of 1932-1972, black people's response to the suggestion of taking part in anything remotely experimental has been mostly, hell, no.

Terminology

Vaccination, inoculation and immunization are often used interchangeably, but there are distinctions:

• Inoculation is the introduction of an infectious agent or toxin designed to produce an immune response without overt illness.
• Vaccination is a specific type of inoculation named by Edward Jenner in reference to vaccinia, which is cowpox. Vacca is Latin for cow.
• Immunization is development of immunity by any means, whether artificial or natural.
• Variolation: the deliberate inoculation of an uninfected person with pustular matter containing the smallpox virus.

Famous Infection Fighters

When I was a nerdy teenager, I loved to read murder mysteries, but my other interests ranged from philosophy to science. I recall being riveted to a paperback that chronicled the history of how scientists discovered bacteria and viruses, and the luminaries who marked the milestones along a fascinating journey that included the development of vaccines. We're talking about Louis Pasteur, Robert Koch, Alexander Fleming, and so on.

My vivid imagination took me back to those bygone centuries when people ignored or misunderstood clues that science freely thrust under their noses. In May 1796, Edward Jenner, in an experiment that would have been deemed unethical in modern times, inoculated an 8-year-old boy, James Phipps, with fluid from a fresh cowpox lesion on the skin of a milkmaid. For years, Jenner had heard milkmaids say, “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” Now Jenner wanted to see if that was true.

 

Edward Jenner vaccinating James Phipps, 1796 (Image: Everett Historical/Shutterstock

Over the next 2 weeks, Phipps had mild flu-like symptoms, but when exposed to the highly infectious smallpox, Phipps was protected from contracting the disease.  Jenner then did a little promotion of his vaccine, basing the word on vacca, Latin for "cow." The 30% lethality rate and horrendous optics of smallpox drove the urgency of finding a cure or prevention. If a person survives, smallpox leaves the most appalling scarring--enough to make one suicidal.

Child with active smallpox (Image:CDC/James Hicks)

Nothing Really New Under The Sun

However, Jenner wasn't the first person to use the inoculation technique against smallpox. Variolation, introducing a person to smallpox material from a patient in the hope that a mild, but protective, infection would result, was practiced in China and India as far back as 1000 or before.  

In 1648, there was a situation that will sound rather familiar to our modern ears: because of an outbreak of yellow fever in Barbados, Cuba, and the Yucatan, strict quarantine was imposed in Boston for all ships returning from the West Indies. Apparently, viruses weren't done with Boston, because in 1657, there was a measles outbreak. In 1694, Queen Mary II died of hemorrhagic smallpox (variola hemorrhagica).

The African Pioneer Very Few Know About

As a child in Ghana, I learned about Jenner, Pasteur, Koch et al., but no one told me nor did I read about a West African slave who brought the practice of inoculation to New England. In 1706, a prominent Puritan minister called Cotton Mather purchased an enslaved West African whom he named Onesimus (Greek for "useful") after the Biblical slave of the same name. This appears in the Epistle of Paul to Philemon, in which Paul says, "I beseech thee for my son Onesimus, whom I have begotten in my bonds: Which in time past was to thee unprofitable, but now profitable to thee and to me . . ."

Onesimus was one of about a thousand Africans in Massachusetts who were servant or slave. Mather hoped Onesimus would repent of "some Actions of a thievish aspect." Apparently the irony of Mather's slave ownership was lost on himself. Onesimus was clearly a smart cookie, because later on, he was able to buy his way out of bondage by paying Mather to purchase another youth, Obadiah, to serve in Onesimus's stead. Slick move, although I feel sorry for Obadiah.

Onesimus, who brought inoculation to Boston
(Photo: Face2faceAfrica.com) 

In 1721, yet another outbreak of smallpox ripped through Boston. At that time, Mather advocated  a technique of "ye Method of Inoculation," remarking that six years before, he had learned about it from "my Negro-Man Onesimus, who is a pretty Intelligent Fellow." Mather had informed the Royal Society of London that Onesimus "had undergone an Operation, which had given him something of ye Small-Pox, and would forever preserve him from it, adding, That it was often used among [Africans] and whoever had ye Courage to use it, was forever free from ye Fear of the Contagion. He described ye Operation to me, and showed me in his Arm ye Scar.” Accounts of smallpox variolation appear from scattered areas of ancient Africa, including Sudan, Ethiopia, and Southern Africa.

Hearing that this technique was also practiced in Turkey, Mather mounted a public campaign in favor of inoculation, but the large majority of white doctors in town were unwilling to try something suggested by an African, except for one physician by name of Zabdiel Boylston, who was the first American doctor to perform gallstone and breast removal surgery. In that same spirit, Boylston went ahead and performed variolation on 282 Boston inhabitants, keeping records on them and 5,759 non-inoculated residents who contracted smallpox. At the time, most people considered variolation ran counter to the will of God, and both Boylston and Mather met with strong opposition and even threats of violence. If this all sounds vaguely familiar, it's because it is. Anti-vaxxers existed in the 1700s just as they do now, and the irony is that 300 years later, the rhetoric is almost identical. Eventually, Boylston was arrested and released only on condition that he would not inoculate anyone else without government approval.

But Boylston was eventually triumphant. Of the 282 inoculated patients, only 2% died from smallpox. Of the nearly 6000 non-inoculated, 15% died. Boylston presented his findings in 1726 to the Royal Society chaired by the Royal Society.

Lessons & Summary

The history of vaccination and inoculation goes back millennia. Many people do not understand that large populations have given their lives through outbreaks of smallpox and other hideous and lethal diseases in order for us to reach modern times in which lifesaving vaccination is available. Smallpox has been largely eradicated in the world as a result, and countless deaths are prevented from diseases like rabies, meningococcus, polio, diphtheria, and yellow fever. Anti-vaxxers should carefully consider whether we really want to return to the 17th and 18th century.

The inoculation story has been largely told from the Eurocentric standpoint, but variolation, a procedure of the same principle, was practiced elsewhere, including in Africa, long before Jenner unveiled vaccination. Yet one would be hard pressed to cite Onesimus's contributions to a medical practice that has been a bedrock of public health and the eradication of disease.

For a detailed history of vaccines, I highly recommend you spend a few minutes looking at this timeline, and next post, I'll talk about the modern age of vaccines.